Role of Transcranial Doppler as a Predictor of Prognosis in Patients with Traumatic Brain Injury
Journal Title: International Journal of Contemporary Medicine surgery and Radiology - Year 2017, Vol 2, Issue 4
Abstract
Background: Traumatic brain injury is one of the leading causes of mortality and morbidity worldwide. Cerebral perfusion abnormalities after brain injury are associated with poor outcome. Transcranial Doppler is useful to identify these subset of patients with low cerebral blood flow. In this article, we review the practical aspects of transcranial Doppler and describe its role in management of traumatic brain injury patients. Material and methods: This is a prospective study in tertiary care hospitals in North Andhra Pradesh, on 75 patients with severe brain injury, as defined by Glasgow Coma Scale. All the patients underwent Transcranial Doppler study to assess the cerebral perfusion. The systolic, diastolic and mean flow velocities along with pulsatility index are documented in bilateral proximal middle cerebral arteries. Patients are categorized depending on normal or abnormal values. Prognosis is assessed by checking the Glasgow coma scale after one month, or by mortality. Results: Out of 75 patients who were evaluated, thirty-six patients (48%) had normal measurements on Transcranial Doppler. Among them, 67% patients had good outcome, 19% patients had poor outcome and 14%patients died. Eighteen patients (24%) had hypoperfusion, of whom, 10 patients had severe neurological impairment and 8 patients progressed to brain death. Twenty-one patients (28%) had vasospasm. Six out of these twenty-one patients died, 11 patients had severe neurological disability and four patients were discharged in good neurological status. Conclusion: Transcranial Doppler provides valuable information about the cerebral haemodynamics, which is essential for prognostication of patients with traumatic brain injury. The value of pulsaltility index correlates well with patient outcome. So, TCD can be used as additional modality in management of patients with TBI.
Authors and Affiliations
B. K. D. Prasad, Madhavi Chamarthi, Pravallika Isireddy
Keywords
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